BMJ Case Reports 2018; doi:10.1136/bcr-2018-225359
  • Unusual association of diseases/symptoms

Neutropaenia and splenomegaly without arthritis: think rheumatoid arthritis

  1. April Chang-Miller1
  1. 1Department of Rheumatology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
  2. 2Internal Medicine, St. Mary’s Hospital, Waterbury, Connecticut, USA
  3. 3Department of Hematology and Oncology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
  1. Correspondence to Dr Fawad Aslam, fawadaslam2{at}
  • Accepted 26 June 2018
  • Published 11 July 2018


Felty syndrome(FS) is an uncommon, but severe, extra-articular manifestation of rheumatoid arthritis (RA). It occurs in patients with longstanding RA. It is extremely rare for RA to present as FS or develop after initially presenting as neutropaenia and splenomegaly. We describe a case of 47-year-old woman who was diagnosed simultaneously with FS and possible RA after testing positive for anticyclic citrullinated peptide antibody, but a negative rheumatoid factor. She had an excellent response to methotrexate. We review the existing literature of such cases and emphasise the importance of serological testing for RA in patients presenting with neutropaenia and splenomegaly, even in the absence of joint symptoms or prior diagnosis of RA.


  • Contributors FA and RSC were involved in the conception, design, data collection, tabulation, writing, revision and approval of the final version. AC-M and MF were involved in writing, data interpretation, revision and approval of final version. All authors vouch for the integrity of the data presented.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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